Claims Advisor, Professional Liability | Medical Malpractice

About the role

Join Sedgwick, a company dedicated to helping people facing unexpected challenges. With 33,000 colleagues worldwide, we offer a caring culture and work-life balance. Our mission is to help you grow your career and make a meaningful impact.

Primary Purpose of the Role

Manage and handle medical malpractice and professional liability claims; provide resolution for claims involving severe injuries; coordinate case management within company standards, industry best practices, and specific client service requirements; and manage total claim costs while delivering high levels of customer service.

Essential Responsibilities

• Analyzes and processes complex or technically difficult liability claims by investigating and gathering information to determine the claim's exposure; manages claims through well-developed action plans to an appropriate and timely resolution.
• Conducts or assigns full investigations and provides reports of investigation regarding new events, claims, and legal actions.
• Negotiates claim settlements up to designated authority level.
• Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout the claim lifecycle.
• Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlements.
• Performs coverage analysis and opinions as part of the claim process, including all necessary correspondence.
• Coordinates legal defense by assigning attorneys, supporting the investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.
• Uses appropriate cost containment techniques, including strategic vendor partnerships, to reduce overall claim costs for clients.
• Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim costs.
• Represents the company in depositions, mediations, and trial monitoring as needed.
• Communicates claim activity and processing with the client; maintains professional client relationships.
• Safeguards claim files and ensures claims coding is correct; refers cases as necessary to supervisor and management.
• Delegates work and mentors others.

Qualifications

• Ten (10) years of complex claims management experience or equivalent combination of education and experience required.
• Masters or Juris Doctorate degree from an accredited college or university preferred.
• Licenses as required, including but not limited to Bachelor of Science in Nursing, Legal Nurse Consultant, Associate in Claims (AIC), Chartered Property and Casualty Underwriter (CPCU), Associate in Risk Management (ARM), Associate in Insurance Claims (AIC), Certified Professional in Health Care Risk Management (CPHRM).

Skills

• In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries, offsets, and deductions, claim and disability duration, cost containment principles including medical management practices, and Social Security application procedures as applicable to line-of-business.
• Extensive knowledge and comprehension of insurance coverage, claims expertise in medical malpractice, errors and omissions, directors and officers, life sciences, and/or cyber liability.
• Excellent oral and written communication, including presentation skills.
• PC literate, including Microsoft Office products.
• Analytical and interpretive skills.
• Strong organizational skills.
• Excellent negotiation skills.
• Good interpersonal skills.
• Ability to work in a team environment.
• Ability to meet or exceed Performance Competencies.

Work Environment Requirements

• Physical: Computer keyboarding.
• Auditory/visual: Hearing, vision, and talking.
• Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to meet deadlines.

Pay and Benefits

The range of starting pay for this role is $100,000 to $125,000. A comprehensive benefits package is offered, including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.